Monoarticular JIA

Author: Pediatric Oncall

Question
A 9 years old boy presented with swelling over left knee joint for 2½ years. He had a history of trauma to the left knee 2½ years back following which there was swelling for 7 days. He was then alright for next 6 months when he again had left knee joint swelling with restriction of movement which has persisted till date. There is no history of fever, other joint involvement or sore throat. He has been treated with Injection Benzathine Penicillin in view of a positive ASLO titre. His echocardiogram is normal. On examination, there is swelling in left knee with synovial thickening and range of movement from 0-110o. Other systems are normal. X-Ray of the knee shows soft tissue swelling. RA factor is negative and ANA, dsDNA are also negative. CBC is normal (WBC count = 10,600/cumm with 73% polymorphs and 24% lymphocytes) and ESR is 9 mm at end of 1 hour). MRI of the knee shows synovial thickening with loculations in the synovial cavity. Bones are normal. A synovial biopsy showed chronic reactive synovitis without granulomatous change confirming the diagnosis of Monoarticular JIA.

How should this child be treated?

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